Each question is worth 25 points 1. At the Integris hospital, a 5-year old Caucasian male child in good general health and physical condition was presented at the Saturday walk-in clinic by his mother. He was brought in because he had a fever, was cranky and had complained of a sore throat for about 24 hours. On physical examination by the attending resident, the patient had a fever of 39.3C, and he had considerable swelling and drainage of the pharynx and in the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His chest sounded clear and he had no additional remarkable findings on routine examination. a) What would be your presumptive diagnosis for this child? Why? b) What diagnostic testing would be indicated to follow this exam? c) What is the most likely treatment for this illness? Why is it important? d) What factors of this case allowed you to make a presumptive diagnosis? e) Lastly, are there any preventative advice that you would give to the mother? 2. A 22-year old white female presents in her physician’s office with genital itching and sharp, severe pain on the labia. She complains of three previous episodes of pain over the past 6 months, each of which were followed by the appearance of red sores which crusted and healed without a scar. On examination the physician observes a cluster of small red blisters localized in the area of the worst pain. No significant discharge was observed from the vagina. The patient’s urine was clear and yellow. Urinalysis revealed normal specific gravity, no sugar, no protein, no white blood cells or red blood cells and no bacteria. The patient’s temperature was 36.5C. The patient history reveals that she is unmarried. She is moderately sexually active and currently using an oral contraceptive which she has been taking for about 4 years. The woman stated that she has had 9 sexual partners over the past year. She reported that her episodes have become progressively more severe. a) What is the cause of this woman’s complaint? b) As her physician, would you recommend that this woman modify her sexual activity? c) Is there an effective treatment for this condition? d) What serious long-term risk does this woman have? 3. A 58-year old Native American presents in the Mercy emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the patient states that he has a very busy life. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain. a) What is your diagnosis here? b). What is the proper treatment of this problem? c). How could this have been prevented? 4. In your opinion, as a pathogen, why would it be advantageous for the Varicella Zoster virus (VZV) to migrate to the nervous system (Latency), and remain there until an outbreak event (signs of manifestations)
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